Footnotes:

Footnotes:[Skip][100]"By Tho. Fallowes, M.D., at his House in Lambeth-Marsh, and to be had there, or at Mr. Jones's Haberdasher in Hats, over against thePumpinChanceryLane, and nowhere else," 1705. A second edition appeared in 1814.[101]In his Review for 1706 there is a "Scheme for the Management of Mad-houses," with a case of abuse.[102]As will be seen by the date, the elder Pitt and Fox.[103]The physician referred to atp. 87.[104]14 Geo. III., c. 49 (1774).[105]"The Early History of Charles James Fox," by G. O. Trevelyan, 1880.[106]Letter written July 30, 1767.[107]"Lady Chatham also, when writing confidentially to Lord Shelburne in the autumn of 1767, observes, 'I wish I could say there was any material change in the state of my Lord's health, but we are forbid to expect that, until he can have a fit of gout.'"[108]"History of England from the Peace of Utrecht," vol. v. pp. 166, 188 (edit. 1853).[109]Page 203.[110]See "Evidence before the House of Commons." See also "Debates on the Regency," Hansard, vol. xxvii.[111]"American Journal of Insanity," July, 1855.[112]See the last edition, corrected by himself (1780), of his "Primitive Physic, or an Easy and Natural Method of curing most Diseases."[113]Page 82.[114]"The State of the Prisons in England and Wales, with Preliminary Observations," by John Howard, F.R.S., 3rd edit., 1784.[115]Ray,American Journal of Insanity, vol. iv. p. 112.[116]"Review of the Early History of the Retreat," by S. Tuke. 1846.[117]"Lettre addressée aux Rédacteurs de la Bibliothèque Britannique sur un nouvel établissement pour la guerison des Aliénés" (1798). Par Dr. Delarive, p. 29.[118]"Review of the Early History of the Retreat," p. 14.[119]The physician who gave his name to the well-known solution of arsenic. Author of a treatise on Arsenic, 1786, and one on Rheumatism in 1795. Jepson resigned in 1822, and died in 1836.[120]"Description of the Retreat," by S. Tuke, p. 62.[121]Pages 11, 12.[122]TheBritish Review(vol. vi. No. xii.), in reviewing this book, observed: "In 1813 Mr. Samuel Tuke published his 'Description of the Retreat,' the celebrated work, the title of which we have placed among others at the head of our article.... The Retreat has been conducted from the beginning upon the principle that the utmost practicable degree of gentleness, tenderness, and attention to the comforts and feelings of the patients was in the first place due to them as human beings; and in the next place was infinitely the most promising means of effecting their recovery. The object of this work of Mr. Tuke was to describe the system of management which had been pursued in the Retreat; to make known the success which had attended it; and to point out more distinctly than had ever yet been done, the principle upon which that management was founded (the principle of gentleness, and of regard to the feelings of the patients) as the grand principle which ought to regulate the management of every establishment of the kind. The service which Mr. Tuke professed to render to the public by his book was assuredly of importance, and his book has performed it well.... In having pointed out this as the governing principle, he has rendered a service to humanity of the greatest importance. It is this characteristic circumstance which will render the publication of his book an era in the history of the treatment of this calamity. The book has already met with great and almost universal attention. It has by the nation been much more than approved; it has been applauded and admired."The reviewer continues: "One thing we may venture to say, that it was hardly possible for a book to be written in a manner less calculated to give offence to anybody.... Yet this book gave prodigious offence. It has been regarded as a libel upon the York Asylum, and an attack upon it has appeared in the newspapers." This was a letter signed "Evigilator," who was in reality the superintendent of the above institution. This led to a long and heated correspondence. About the same time a charge of ill treatment of a patient in the York Asylum was made by a magistrate (Mr. Godfrey Higgins of Doncaster), whose persistent endeavours to bring this and other cases to the light of day were beyond praise, and happily proved successful at last.The writer has in his possession a mass of private letters which passed between his father and Mr. Higgins on these cases, which indicate their combined endeavours, made (under the fiercest opposition) to reform the horrible abuses which had converted a well-intentioned charity into a hell upon earth. Mr. Higgins was the author of a book on Mahomet, the remarkable work on the Celtic Druids (1827), and of "Anacalypsis" (1836).[123]April, 1814, pp. 190, 194, 198.[124](1) "Practical Hints on the Construction and Economy of Pauper Lunatic Asylums; including Instructions to the Architects who offered Plans for the Wakefield Asylum, and a Sketch of the most approved Design." York, 1815. (2) "On the Construction and Management of Hospitals for the Insane," by Dr. Jacobi, with Introduction by Samuel Tuke, 1841. Born 1784; died 1857. An Honorary Member of the Medico-Psychological Association.[125]The incompleteness of this Parliamentary return was shown by the fact that, a few weeks afterwards, Sir Andrew Halliday found that in Norfolk there were 112 instead of 42.[126]51 Geo. III., c. 74; also in 1815, May 2 (55 Geo. III., c. 46), independently of the Report of the Select Committee. Overseers were to make returns of all lunatics and idiots within their parishes. These Acts do not touch "Private mad-houses"—only paupers.[127]"What strenuous efforts fruitlessly combined to accomplish, a little volume has at once achieved. I hardly need name Mr. Samuel Tuke's account of the Retreat. Mr. Tuke's work, operating on a suspicious and irritable mind, produced the letters signed 'Evigilator;' the public attention became aroused, doubts and surmises were started. Either confident in right, or daring in wrong, a general challenge was given; that challenge was answered, with what results it is needless to add" (vide"Papers respecting the York Lunatic Asylum," by S. W. Nicoll, Esq., 1816).[128]"Les Principes à suivre dans la Fondation et la Construction des Asiles d'Aliénés," Paris, 1853, p. 226.[129]American Journal of Insanity, April, 1856.[130]Ibid., October, 1863, p. 205.[131]"Review of the Early History of the Retreat," by S. Tuke, 1846.[132]Referring to the practice at the Retreat as given in the "Description," the editor of theMedical Repository, 1817, after observing, "We are told that in violent maniacal paroxysms, depletion having failed to procure quiescence, a full meal of meat and good porter for supper produced the desired effect, and that this mode has since been very frequently and successfully employed," adds that if this be true, the general system of well-known physicians, that of pursuing depletion through "paroxysm and remission," cannot be right.[133]Tuke's "Description," p. 113.[134]Page 156.[135]"If it be true that oppression makes awiseman mad, is it to be supposed that stripes and insults and injuries, for which the receiver knows no cause, are calculated to make amadman wise? or would they not exasperate his disease and excite his resentment" ("Description of the Retreat," 1813, p. 144).[136]Including cases in seclusion.[137]"Description of the Retreat," S. Tuke.[138]A Savoy physician who dedicated the second edition of his "La Philosophie de la Folie," published in 1804, to Pinel. M. Brierre de Boismont thinks the latter guilty of "the conspiracy of silence" in not mentioning him in his work, but I do not think the conspiracy is proved.[139]SeeAppendix C.

[Skip]

[100]"By Tho. Fallowes, M.D., at his House in Lambeth-Marsh, and to be had there, or at Mr. Jones's Haberdasher in Hats, over against thePumpinChanceryLane, and nowhere else," 1705. A second edition appeared in 1814.

[101]In his Review for 1706 there is a "Scheme for the Management of Mad-houses," with a case of abuse.

[102]As will be seen by the date, the elder Pitt and Fox.

[103]The physician referred to atp. 87.

[104]14 Geo. III., c. 49 (1774).

[105]"The Early History of Charles James Fox," by G. O. Trevelyan, 1880.

[106]Letter written July 30, 1767.

[107]"Lady Chatham also, when writing confidentially to Lord Shelburne in the autumn of 1767, observes, 'I wish I could say there was any material change in the state of my Lord's health, but we are forbid to expect that, until he can have a fit of gout.'"

[108]"History of England from the Peace of Utrecht," vol. v. pp. 166, 188 (edit. 1853).

[109]Page 203.

[110]See "Evidence before the House of Commons." See also "Debates on the Regency," Hansard, vol. xxvii.

[111]"American Journal of Insanity," July, 1855.

[112]See the last edition, corrected by himself (1780), of his "Primitive Physic, or an Easy and Natural Method of curing most Diseases."

[113]Page 82.

[114]"The State of the Prisons in England and Wales, with Preliminary Observations," by John Howard, F.R.S., 3rd edit., 1784.

[115]Ray,American Journal of Insanity, vol. iv. p. 112.

[116]"Review of the Early History of the Retreat," by S. Tuke. 1846.

[117]"Lettre addressée aux Rédacteurs de la Bibliothèque Britannique sur un nouvel établissement pour la guerison des Aliénés" (1798). Par Dr. Delarive, p. 29.

[118]"Review of the Early History of the Retreat," p. 14.

[119]The physician who gave his name to the well-known solution of arsenic. Author of a treatise on Arsenic, 1786, and one on Rheumatism in 1795. Jepson resigned in 1822, and died in 1836.

[120]"Description of the Retreat," by S. Tuke, p. 62.

[121]Pages 11, 12.

[122]TheBritish Review(vol. vi. No. xii.), in reviewing this book, observed: "In 1813 Mr. Samuel Tuke published his 'Description of the Retreat,' the celebrated work, the title of which we have placed among others at the head of our article.... The Retreat has been conducted from the beginning upon the principle that the utmost practicable degree of gentleness, tenderness, and attention to the comforts and feelings of the patients was in the first place due to them as human beings; and in the next place was infinitely the most promising means of effecting their recovery. The object of this work of Mr. Tuke was to describe the system of management which had been pursued in the Retreat; to make known the success which had attended it; and to point out more distinctly than had ever yet been done, the principle upon which that management was founded (the principle of gentleness, and of regard to the feelings of the patients) as the grand principle which ought to regulate the management of every establishment of the kind. The service which Mr. Tuke professed to render to the public by his book was assuredly of importance, and his book has performed it well.... In having pointed out this as the governing principle, he has rendered a service to humanity of the greatest importance. It is this characteristic circumstance which will render the publication of his book an era in the history of the treatment of this calamity. The book has already met with great and almost universal attention. It has by the nation been much more than approved; it has been applauded and admired."The reviewer continues: "One thing we may venture to say, that it was hardly possible for a book to be written in a manner less calculated to give offence to anybody.... Yet this book gave prodigious offence. It has been regarded as a libel upon the York Asylum, and an attack upon it has appeared in the newspapers." This was a letter signed "Evigilator," who was in reality the superintendent of the above institution. This led to a long and heated correspondence. About the same time a charge of ill treatment of a patient in the York Asylum was made by a magistrate (Mr. Godfrey Higgins of Doncaster), whose persistent endeavours to bring this and other cases to the light of day were beyond praise, and happily proved successful at last.The writer has in his possession a mass of private letters which passed between his father and Mr. Higgins on these cases, which indicate their combined endeavours, made (under the fiercest opposition) to reform the horrible abuses which had converted a well-intentioned charity into a hell upon earth. Mr. Higgins was the author of a book on Mahomet, the remarkable work on the Celtic Druids (1827), and of "Anacalypsis" (1836).

The reviewer continues: "One thing we may venture to say, that it was hardly possible for a book to be written in a manner less calculated to give offence to anybody.... Yet this book gave prodigious offence. It has been regarded as a libel upon the York Asylum, and an attack upon it has appeared in the newspapers." This was a letter signed "Evigilator," who was in reality the superintendent of the above institution. This led to a long and heated correspondence. About the same time a charge of ill treatment of a patient in the York Asylum was made by a magistrate (Mr. Godfrey Higgins of Doncaster), whose persistent endeavours to bring this and other cases to the light of day were beyond praise, and happily proved successful at last.

The writer has in his possession a mass of private letters which passed between his father and Mr. Higgins on these cases, which indicate their combined endeavours, made (under the fiercest opposition) to reform the horrible abuses which had converted a well-intentioned charity into a hell upon earth. Mr. Higgins was the author of a book on Mahomet, the remarkable work on the Celtic Druids (1827), and of "Anacalypsis" (1836).

[123]April, 1814, pp. 190, 194, 198.

[124](1) "Practical Hints on the Construction and Economy of Pauper Lunatic Asylums; including Instructions to the Architects who offered Plans for the Wakefield Asylum, and a Sketch of the most approved Design." York, 1815. (2) "On the Construction and Management of Hospitals for the Insane," by Dr. Jacobi, with Introduction by Samuel Tuke, 1841. Born 1784; died 1857. An Honorary Member of the Medico-Psychological Association.

[125]The incompleteness of this Parliamentary return was shown by the fact that, a few weeks afterwards, Sir Andrew Halliday found that in Norfolk there were 112 instead of 42.

[126]51 Geo. III., c. 74; also in 1815, May 2 (55 Geo. III., c. 46), independently of the Report of the Select Committee. Overseers were to make returns of all lunatics and idiots within their parishes. These Acts do not touch "Private mad-houses"—only paupers.

[127]"What strenuous efforts fruitlessly combined to accomplish, a little volume has at once achieved. I hardly need name Mr. Samuel Tuke's account of the Retreat. Mr. Tuke's work, operating on a suspicious and irritable mind, produced the letters signed 'Evigilator;' the public attention became aroused, doubts and surmises were started. Either confident in right, or daring in wrong, a general challenge was given; that challenge was answered, with what results it is needless to add" (vide"Papers respecting the York Lunatic Asylum," by S. W. Nicoll, Esq., 1816).

[128]"Les Principes à suivre dans la Fondation et la Construction des Asiles d'Aliénés," Paris, 1853, p. 226.

[129]American Journal of Insanity, April, 1856.

[130]Ibid., October, 1863, p. 205.

[131]"Review of the Early History of the Retreat," by S. Tuke, 1846.

[132]Referring to the practice at the Retreat as given in the "Description," the editor of theMedical Repository, 1817, after observing, "We are told that in violent maniacal paroxysms, depletion having failed to procure quiescence, a full meal of meat and good porter for supper produced the desired effect, and that this mode has since been very frequently and successfully employed," adds that if this be true, the general system of well-known physicians, that of pursuing depletion through "paroxysm and remission," cannot be right.

[133]Tuke's "Description," p. 113.

[134]Page 156.

[135]"If it be true that oppression makes awiseman mad, is it to be supposed that stripes and insults and injuries, for which the receiver knows no cause, are calculated to make amadman wise? or would they not exasperate his disease and excite his resentment" ("Description of the Retreat," 1813, p. 144).

[136]Including cases in seclusion.

[137]"Description of the Retreat," S. Tuke.

[138]A Savoy physician who dedicated the second edition of his "La Philosophie de la Folie," published in 1804, to Pinel. M. Brierre de Boismont thinks the latter guilty of "the conspiracy of silence" in not mentioning him in his work, but I do not think the conspiracy is proved.

[139]SeeAppendix C.

I nowresume the thread of my history at the time of the exposure of the abuses at the old York Asylum.

We have already intimated that the treatment adopted at the Retreat, and made known to the public by various writers and by many visitors, but more especially by the "Description," exerted a remarkable influence on the subsequent inquiry and legislation. The success of the Retreat excited the jealousy and antipathy of the superintendent of the York Asylum; the discussion which ensued led to investigation; the revelations which followed excited public opinion; the representatives of the people undertook an inquiry by means of a Select Committee, which finally necessitated legislation, and this legislation by successive enactments wrought the wondrous and beneficial change which we now witness. This sequence of events will be found to be borne out by facts, by any one who will investigate the literature of lunacy from 1792 to the present time. Sydney Smith says, writing in 1817,[140]that "the newEstablishment began the great revolution upon this subject, which we trust the provisions of Parliament will complete.... In the course of a few years the Institution had done so much by gentle methods, that a modest and well-written volume, giving an account of it, excited universal interest, and, in fact, achieved what all the talents and public spirit of Mason and his friends had failed to accomplish. It had still better effects. A very inoffensive passage in this book roused, it seems, the animosity of the physician to the York Lunatic Asylum, and a letter which this gentleman published in one of the York newspapers, became the origin of a controversy among the governors of that establishment, which terminated in August, 1814, after a struggle of nearly two years, in the complete overthrow of the old system, and the dismission of every officer of the asylum, except the physician himself. The period is not remote when lunatics were regarded as beings unsusceptible of mental enjoyment or of bodily pain, and accordingly consigned without remorse, to prisons under the name of mad-houses—in the contrivance of which nothing seems to have been considered, but how to enclose the victim of insanity in a cell, and to cover his misery from the light of day. But the success of the Retreat demonstrated, by experiment, that all the apparatus of gloom and confinement was injurious; and the necessity for improvement becoming daily more apparent, a 'Bill for the Better Regulation of Mad-houses' was brought into Parliament by Mr. Rose in 1813, but was nevertheless opposed and finally withdrawn; and another Bill, in1814,[141]though it passed the Commons, was rejected by the House of Lords. The public, in fact, was not yet aware of the atrocious evils which these Bills were intended to remove; and it was not until now that the course was adopted, which, in every case of public grievance, is the only sure one for obtaining redress. A Committee of the House of Commons, appointed for the purpose of inquiry in 1814, and revived in the following year, was fortunately composed of men determined to do the business they had undertaken."[142]

Mr. Rose, on the 28th of April, 1815, again introduced the subject of private mad-houses to Parliament, and, dwelling on the great abuses connected with them, pointed out the necessity of their condition being examined into by the House. He said that among the cases which had recently come to his knowledge was that of a young woman who, although requiring some restraint, was perfectly harmless. She was found chained to the ground by both legs and arms, a degree of cruelty which was in no respect justified. With a view of correctingsuch practices, he moved "that a Committee be appointed to consider of provision being made for the better regulation of mad-houses in England, and to report the same, with their observations thereupon, to the House."[143]The motion was agreed to.

The York Lunatic Asylum stood first upon the evidence before the Select Committee. "It appears from the history of that institution, which was published at the close of the controversy above alluded to, that the victory of the reformers was not obtained without strong opposition; for, at the very moment when the state of things that we shall presently detail was flourishing in full enormity, their opponents were enabled to carry a resolution of the governors, declaring that a lunatic, who appears to have sustained gross injury, 'had been treated with all possible care, attention, and humanity,' and censuring the parties who brought forward the complaint.... On a subsequent day thirteen spirited men (including Mr. Higgins and Mr. Tuke) determined toenforceinvestigation; and, having qualified themselves as governors by paying the requisite donation of £20 each, succeeded in obtaining the appointment of a Committee to inquire into the complaints that had been exhibited; which, after meeting for several successive days, and examining witnesses, concluded by adopting Resolutions of censure upon the proceedings proved before them."[144]

One day Mr. Higgins went to the asylum. Afterhaving seen all the patients' rooms, he went with the steward to the kitchen. There he was struck with "the retired appearance" of a door. He ordered a keeper to unlock it. He perceived fear and hesitation. He repeated his order in stronger language. The key not being readily forthcoming, Mr. Higgins grew warm, and declared he would soon find a key that would open it at the kitchen fireside. It was then opened. He went in, and discovered a row of cells, four in number, which had been concealed from the committee of investigation. On entering the first cell, he found it in a state dreadful beyond description. The cell was about eight feet and a half square, perfectly dark when the door was shut, and the stench almost intolerable. He was told these cells were occupied at night by thirteen women, who were then upstairs; where he found them in a room twelve feet long by seven feet ten inches wide, with a window, which not opening would not admit of ventilation. Sydney Smith well says, after citing more horrible details than I have given, that he is aware of the disgust which they will cause, but that he cannot spare his readers, and asks of the most delicate of them whether it is more shocking that these things should exist unknown, and consequently unredressed, than that they should be told and punished, andremembered for ever, as the only means of preventing their recurrence.

To enter into much detail is impossible. It must suffice to say that case after case of gross neglect and cruelty was brought to light; that while 365 patients had died, only 221 had been reported; that a patienthaving been killed, his body was hurried away to prevent an inquest; that when the accounts were examined, it was discovered that two sets of books of receipts were kept, one of which was only presented to the governors, and that the difference between the sums contained in the two, amounting to some hundreds a year, found its way into the pocket of the superintendent; and lastly we must record that one wing of the asylum was burned, involving the deaths of patients and the destruction of much that it was with good reason believed the authorities wished to conceal.

Of the revelations made by the Committee of the House of Commons in regard to Bethlem Hospital, we shall only briefly speak. We have already sketched the history of this institution. For the most part it is to thesecondBethlem—that in Moorfields—the minutes of evidence refer. During the seven years prior to the investigation, the number of patients averaged 238; the annual expenditure, £12,000. Mr. Haslam, the resident apothecary, ruled supreme. He was responsible for the dreadful condition in which the notorious Norris was discovered. "There is," says Sydney Smith, "much evasive testimony, to shift from himself the burden of this atrocious case; but his efforts tend rather to confirm than to shake the conviction which the evidence produces.... The conduct of Haslam with respect to several other patients was of a corresponding description; and in the case of a gentleman whose death was evidently accelerated by the severities he underwent, and of several other persons, there is abundant proof ofcruelty.... It is in proof that a patient actually died, through mere neglect, from the bursting of the intestines, overloaded for want of aperient medicine, and it is expressly stated by Haslam himself that a person whom he asserts to have been 'generally insane and mostly drunk,' whose condition, in short, was such 'that his hand was not obedient to his will,' was nevertheless retained in the office of Surgeon, and continued to attend the patients for a period often years—a statement so atrocious that, from any other quarter, we should have rejected it as utterly incredible."[145]

The governors easily convinced themselves that no foundation whatever existed for the charge of cruelty and bad management; that every degree of permissible indulgence had been observed; that the hospital was equal, if not superior, to any other asylum in England; that the mode of confining the unhappy Norris appeared "to have been, upon the whole, rather a merciful and humane, than a rigorous and severe imposition;" in short, that "the general management of Bethlem, as affecting the health, the cleanliness, and the comfort of the patients, was of a naturecreditable to the governors and others concerned in its administration." What a picture of the standard of excellence held by the managers of asylums at that period, not in Bethlem alone, but generally!

To the question, "Has there not been a rule in the hospital, for a certain number of years, that, in certainmonths of the year, particular classes of the patients should be physicked, bled, bathed, and vomited, at given periods?" the reply from Bethlem was in the affirmative. Twice in the year the patients, with few exceptions, were bled. "After they have been bled," said the physician, in evidence, "they take vomits once a week for a certain number of weeks; after that, we purge the patients. That has been the practice, invariably, for years—long before my time."

In regard to the means of coercion employed, it was stated that the patients "are generally chained to the wall with manacles." When inquiry was made regarding the use of strait waistcoats, it was replied, "I do not believe there are any strait waistcoats in Bethlem now, or very few indeed; they generally use irons." The objection to strait waistcoats was, that the patients "could not help themselves in strait waistcoats; they are so excessively long in the hospital without being seen by anybody, in a dark place; in winter, from four o'clock to six or seven in the morning. If they were in a strait waistcoat they could not assist themselves the least in the world." When, in the following year, the head-keeper of Bethlem Hospital was asked, "Was it not the practice in old Bethlem—not in the late gallery, but in the gallery pulled down—for eight, ten, or more patients to be fastened to the tables, almost in a state of perfect nakedness?" he replied, "Yes; they used to think they tore their clothes all to pieces; some of them would do that." "In point of fact, were they not fastened to the tables, sitting in a state of perfectnudity?" Answer: "They used to be so at the table; they were chained all round." In regard to the apparatus, so ingeniously cruel, by which one of the patients (Norris) was chained ten or twelve years, Haslam, the apothecary at Bethlem, when asked, "Do you think that his confinement in that manner during the whole of that period was necessary?" replied, "Decidedly."

The matron of Bethlem Hospital (who was elected January, 1815) gave evidence that, when she was appointed, there were about twenty patients under personal restraint, out of between fifty and sixty patients. "The custom when I first went was only to get them up three days of the week—never on meat days; they lie in bed four days in the week." She also stated that one of the female patients had been chained for eight years, but had not required restraint since she had been there.

Bethlem, however, was far from being the only place where patients were treated like wild beasts. Mrs. Mary Humieres, formerly housekeeper in a private asylum at Bethnal Green, gave evidence to an attendant "kicking the patients and thumping them sadly," and "beating one in his shirt with a pair of boots, in a most dreadful manner." She named a female patient who, when in a state of irritation, "was confined in a place in the yard which was originally a pig-sty; it was run up high on purpose for her. I have seen her confined there for three weeks together. She has been ironed there in the crib with wrist-locks, and leg-locks, and a chain two or three times across her body." An iron bar was placed between her legs when she walked about, to prevent her escaping."It was confined to each ankle, with a chain coming up between her legs, which was attached to her handcuffs." But, in addition to this frightful restraint, we are informed that an attendant, at the instance of the proprietor, would, "at sundry times," lock her down in her crib with wrist-locks and leg-locks, and horsewhip her. "I have seen the blood follow the strokes." Yet this patient is described as very harmless; "you might sit and talk to her when she was in the highest state."

The Committee found that at a private asylum—Fonthill, Wilts—there was in that year, out of fourteen patients, only one without fetters or handcuffs, and only three out of their sleeping-rooms.[146]

At the Bethnal Green Asylum "several of the pauper women were chained to their bedsteads, naked, and only covered with a hempen rug," and "the accommodation for paupers was infamously bad, and required immediate reform;" while in January of the same year it is reported that "some pauper men were chained upon their straw beds with only a rug to cover them, and not in any way defended from the external cold."[147]

Dr. John Weir was asked, at the Committee of 1815,to what he attributed the difference of opinion among even enlightened men as to the management of the insane. He replied that it was chiefly due to the want of practical observation, as it is only by comparison that we are enabled to appreciate the superiority of one institution over another. He added that, until within the last eighteen years, the primary object of almost every insane institution, whether of a public or private description, had been merely the security of these pitiable objects; comfort, medical and moral treatment, had been in a great measure overlooked. "Happily, however, for that class of society, the Retreat at York had at last convinced the world how much may be done towards the amelioration of their condition."[148]

On the 11th of July, 1815, Mr. Rose brought up the Report of this Committee. On moving that it be printed, he said that all who read the Report must feel satisfied of the indispensable necessity of legislative interference. The way in which lunatics were usually confined was that of criminals, and their treatment was in general worse than the ordinary treatment in jails. The number of persons appointed to take care of them was in most cases utterly insufficient, in consequence of which the greatest severity was too frequently resorted to.

The conclusions arrived at in this celebrated Report may be thus summarized: That keepers of houses for the insane received a much greater number of persons than they were calculated for, thus greatly retarding their recovery; that the number of attendants being insufficient,there was unavoidably a larger amount of restraint than would otherwise be necessary; that outrageous patients were mixed with the quiet and inoffensive; that there was an absence of medical attention to the malady for which the patients were confined; that the certificates on which patients were received into asylums were insufficient, and that the visitation of private mad-houses was defective.

The Report concluded that "some new provision of law is indispensably necessary for ensuring better care being taken of insane persons, both in England and Ireland, than they have hitherto experienced; the number of whom appear to be very considerable, as the inquiries of the Committee have convinced them that there are not in the country a set of beings more immediately requiring the protection of the legislature than the persons in this state, a very large proportion of whom are entirely neglected by their relatives and friends. If the treatment of those in the middling or in the lower classes of life shut up in hospitals, private mad-houses, or parish workhouses, is looked at, your Committee are persuaded that a case cannot be found where the necessity for a remedy is more urgent."

The evidence taken before the Committee of 1815 was so full and convincing that it would have seemed wholly unnecessary to have required a further disclosure of the abuses rampant in the asylums of England, but in consequence of the demand for further investigation before the House of Commons committed itself to legislation, a mass of further particulars was obtained in1816 in regard to the state of various institutions, including Bethlem Hospital and the York Asylum.

In February Mr. Rose had said in the House that, as chairman of the Committee for inquiry into the conduct of mad-houses, he was instructed to move for leave to bring in a Bill for the better regulation of such establishments. But some gentlemen of the Committee being desirous that further investigation should take place, he had acceded to their wish, although the majority concurred with him in thinking that sufficient evidence had already been adduced to justify the proposal of a Bill. Therefore, he should propose, instead of a Bill, that a Committee be appointed to consider of provision being made for the better regulation of mad-houses in England, and report the same, with their observations thereupon, to the House.

On May 28th Mr. Rose brought up the Report of the Committee, and obtained leave to bring in a Bill pursuant thereto. This Bill was for the repeal of the 14th and 55th of the King. He said[149]the Committee had, after the most patient investigation, adopted the provisions of the present Bill, which principally were, that instead of the physicians of the neighbourhood, or those in or near the metropolis, together with a neighbouring magistrate, being the inspectors of such establishments, they should be twice a year examined, etc., by eight Commissioners appointed by the Secretary of State for the Home Department throughout the kingdom; the Commissioners to be assisted by two of the local magistrates ineach district, and with equal powers. There was also a provision in the Bill relative to the erection of lunatic asylums in counties, and the ordering the reception therein of pauper lunatics allowed at present to range abroad, to their own and the public injury.

On the 17th of June, Mr. Rose moved that the clauses of this Bill be taken into further consideration. Lord R. Seymour observed that when Parliament in 1774 passed the "Bill for the Regulation of Licensed Mad-houses," it must have meant to do three things: (1) To secure all persons against unnecessary confinement; (2) to better the chance of recovery of all such persons confined as being insane, as well by moral treatment as by the use of medicine; and (3) to insure the restoration of all who might become again of sound mind to society. But the Mad-house Act, he said, does none of these three things, for it does not empower the Commissioners to discharge a patient, however sound in mind; nor does it furnish them with the means of enforcing the observance of any improvement they may recommend. The Commissioners, indeed, may withdraw the licence, but the keeper of such a house must again have it on the next licensing day, if he wishes, upon giving the necessary security. It was not surprising, therefore, that the greatest abuses should have been found to prevail.

Mr. Wynn expressed a wish that magistrates should be empowered to examine houses where only one patient was confined.[150]

This Bill passed the House, but was rejected by the House of Lords.

Thus all the mass of valuable and decisive evidence which had been collected with so much labour, and had occupied the time and thought of two Committees of the House of Commons, was, for the time, thrown away, and the misery of the inmates of asylums allowed to go unrelieved. The facts, however, had been made widely known. The inertia, torpor, and indifference to human suffering—in short, the crime which characterized the majorities who threw out the Bills calculated to remove the abuses in asylums, had at last to give way to the popular demand. What was gained by prolonging the dismal condition of these abodes of woe for some years longer, I leave others to discover.

After the lapse of three years, namely, on the 10th of March, 1819, Mr. Wynn[151]rose to move for leave to bring in a "Bill for the Regulation of Mad-houses," and observed that, as this subject had been already several times before the House, he did not feel it necessary to trespass long upon its attention. It would be remembered, he said, that some years ago the Report of a Committee had been laid before the House, detailing such scenes of misery and wretchedness in mad-houses, as had perhaps never been paralleled, and after such an exposure it was the obvious duty of the House to follow up the Report by the adoption of some legislative measure calculated to put an end to the evils complained of. There was,however, no fault to be found with the conduct of that House; for it had done its duty by repeatedly sending up a Bill to the other House, which it had thought proper to reject. Although no mad-houses could be legally opened without a licence, the College of Physicians was not in possession of funds to prosecute. He therefore proposed that a general Board of Inspection for mad-houses should be appointed, and that the members of that Board should be at liberty to visit such houses throughout the country, at different and uncertain times, so as to ascertain the manner in which they were conducted, and to report any existing evil to the Board, which should be invested with power to enforce their correction. Mr. Wynn moved for leave to bring in a Bill for repealing the Act of the 14th and 55th of the King with respect to mad-houses, and for making other provisions for their better regulation.[152]

Leave was given to bring in the Bill.

In June of the same year the Marquis of Lansdowne, speaking on the Bill in the House of Lords, said that nothing could more forcibly appeal to the humanity of their lordships than the state of the unfortunate insane, and the legislative means of preventing abuses of the most flagrant and revolting nature, which had long been too clearly proved. Strange to say, however, the Lord Chancellor (Lord Eldon) opposed the Bill, observing that there could not be a more false humanity than an over-humanity with regard to persons afflicted with insanity. (Is not an under-humanity nearly as false?)He admitted there were great abuses, but the better way to remedy them would be to take a cool and dispassionate view of the subject in a Committee, next session. As if there had not been Committees enough! With regard to pauper lunatics, the Lord Chancellor went so far as not only to admit there were great abuses, but to agree to a short Bill, if desired, embodying the clauses relating to them in the measure before the House.

The Bill was thrown out, only fourteen doing themselves the credit of voting in its favour, while thirty-five voted against it. Majority against the Bill, twenty-one.

An "Act for making Provision for the Better Care of Pauper Lunatics in England"[153]was, however, passed (July 12, 1819), but it consisted of three sections only, and does not appear to be an advance, in any essential particular, upon previous Acts. The form of the medical certificate for a pauper lunatic is prescribed.[154]Again, the Act is permissive as regards the action of the justices in causing the overseers to bring the lunatic before them, and calling in a medical man to their assistance.

Four years afterwards, on June 30, 1823, the subject of private mad-houses again came before the House. A petition from John Mitford for an inquiry into the state of private mad-houses was ordered to lie on the table. Mr. Wynn, as on a former occasion, spoke, and observed that three Bills had, at recent periods, been sent up from that House to the Lords, relative to the inspection of houses of this description. He regretted to say they had not been passed. It is extraordinary that Mr. Wynn should have ended his speech by saying that, although he believed abuses might exist in some of these establishments, they were on the whole well conducted. Mr. (afterwards Lord) Brougham said that he knew Dr. Warburton, against whom charges had been brought, and that his character stood equally high both for medical skill and for humanity!

Writing in 1827, Sir Andrew Halliday[155]says, "The evidence taken before Mr. Rose's Committee, which sat for more than one session, must be fresh in the recollection of every one of my readers.... He was at great pains to prepare a Bill which, in the opinion of all who had heard the evidence, and had taken a disinterested part in the investigation, was well calculated to remedy every evil either ascertained or anticipated. The subject was dispassionately canvassed in the Lower House, and the Bill passed by the Commons, almost unanimously, three or four several times; but it was uniformly rejected by the Lords, and after Mr. Rose's death it got intoChancery, and there it has slept for the lastnine years. I do not mean this remark in any manner as a jest; for, literally and truly, the late Lord Chancellor [Lord Eldon] took the whole matter upon his own shoulders, and promised to prepare a measure more suited to the exigencies of the sufferers than any that the collected wisdom of the Commons of England, in Parliament assembled, could think or devise.... The House of Commons has again taken up the matter, and I trust they will not abandon it, even though they should be opposed, until some provision is made against the recurrence of those evils, very trifling in comparison of former times, which during their last short inquiry were found still to exist." Sir A. Halliday points out that, although twenty years had elapsed since Mr. Wynn's Act passed (having received subsequently several amendments), asylums had only been opened in the counties of York (Wakefield, 1818), Lancaster (1816), Nottingham (1812), Norfolk (1814), Stafford (1818), Bedford (1812), Gloucester (1823), Lincoln (1820), and Cornwall (1820)—nine out of the fifty-two counties of England and Wales. Suffolk had just finished its building, as had Chester a short time before. Only at that very time had the magistrates of Middlesex, after two years' deliberation, announced that a county asylum was necessary, although it had been proved by Lord R. Seymour that 873 persons were suffering neglect and cruel treatment for want of it!

Returns ordered by Parliament in 1826 show that there were 1321 persons in private asylums, exclusive ofthose in London and within a radius of seven miles; 1147 in public asylums, exclusive of those in St. Luke's and Bethlem; and 53 in public jails; giving a total of 2521 for the several counties of England and Wales. Those in private asylums in and near London being estimated at 1761, and the asylums of St. Luke's and Bethlem at 500, the gross total for England and Wales was 4782. Sir Andrew Halliday did not hesitate to assert, after very careful inquiry, that the number actually in confinement, not only in the asylums, but with relations and keepers, exceeded 8000. He thought there were very few in Wales, or in "the Celtic tribes in other portions of the empire."[156]

Before leaving Halliday, I may add that he regarded Bethlem as, at this period, well conducted, but as having "too much of the leaven of the dark ages in its constitution, and too rigid a system of quackery, in regard to its being seen and visited by respectable strangers." He adds that in some respects "it is little better than when, in fact, it formed one of thelionsof the metropolis, and the patients as wild beasts were shown at sixpence for each person admitted." Of St. Luke's he writes, "It is only fit to become a prison for confirmed idiots." He would have been surprised to witness how much can be effected by improvements of various kinds, although hemight still wish that it were supplemented by some appendage in the country, if not removed there altogether.

A very important step was taken by Mr. R. Gordon in the House of Commons in 1827 (June 13th), by drawing attention to the pauper lunatics in Middlesex. He particularly referred to the dreadful state of misery of the pauper lunatics in London in the parishes of Marylebone and St. George's. When the overseers of the latter parish visited Dr. Warburton's asylum at Bethnal Green, they found, he said, in a room eighteen feet long, sixteen cribs,[157]with a patient in each crib, some of them chained and fastened down, and all of them in a state of great wretchedness. On one occasion, a visitor having gone there and reported that there was nothing objectionable, he repeated his visit next day, and discovered five rooms, in which the patients were in a most horrid state of misery; and this although the day before he was informed that he had seen everything. The unfortunate persons placed in these cribs were kept from Saturday night until Monday; their food being administered to them in the cribs. Mr. Gordon moved for a Select Committee to inquire into the condition of pauper lunatics in Middlesex, and for leave to bring in a Bill to amend 14 Geo. III. c. 49 (1774),[158]andto extend its provisions to pauper lunatics, to consolidate all Acts relative to lunatics and asylums, and to make further provisions thereto.

The Committee was appointed.

It specially directed its attention to the treatment of paupers in the parishes of Marylebone, St. George, Hanover Square, and St. Pancras, confined in the White House at Bethnal Green, belonging to Dr. Warburton. Its condition was frightful, and the Committee observes that if the White House is to be taken as a fair specimen of similar establishments, it cannot too strongly or too anxiously express its conviction that the greatest possible benefit will accrue to pauper patients by the erection of a county lunatic asylum.

The Committee reports that the defects and abuses in the management of houses for the reception of lunatics, to which the Select Committee of 1815 called the attention of the House of Commons, still exist in licensed houses where paupers are received in the neighbourhood of the metropolis, and that similar abuses elsewhere prevail. The evidence established that there was no due precaution with respect to the certificate of admission, the consideration of discharge, or the application of any curative process to the mental malady. The Committee therefore repeated the recommendationsof the Committees of 1807 and 1815, and prepared a series of propositions as the basis of future legislation, repealing a number of Acts and recommending the consolidation, into one Act of Parliament, of the provisions for the insane, as well as further facilitating the erection of county asylums, and improving the treatment of pauper and criminal lunatics.

Dr. John Bright, secretary to the Commissioners, read from their records one entry, describing the condition of Holt's house, Lewisham, in Kent. In the year 1820, "in a close room in the yard, two men were shut by an external bolt, and the room was remarkably close and offensive. In an outhouse at the bottom of the yard, ventilated only by cracks in the wall, were enclosed three females. The door was padlocked; upon an open rail-bottomed crib herein, without straw, was chained a female by the wrists, arms, and legs, and fixed also by chains to the crib. Her wrists were blistered by the handcuffs; she was covered only by a rug. The only attendant upon all the lunatics appeared to be one female servant, who stated that she was helped by the patients."

Subsequent entries did not show any material improvement in the condition of the house.

Dr. Bright summarized the defects in the Lunacy Laws at that period, as regards the power vested in the Commissioners, as follows:—

"They are very defective in many points: in the first place, with respect to the granting licences, there is only one day in the year in which, according to the Act, thelicences can be granted; then with respect to persons to whom the licence may be granted, any person applying for that licence is entitled to have one; again, any person committing any offence, save and except the refusing admission to Commissioners on their visitations, may be continued and is continued in the exercise of such powers as that licence communicates to him; the Commissioners have no power to disturb in the management of his house any keeper of a house, whatever offences he may have committed, or however unworthy he may appear to them to be. Supposing any person who had, in the eyes of the Commissioners, acted improperly, to apply in October, at the usual and the only period in the year for granting licences, they conceive (and they are advised) that they are obliged to grant a licence to that individual. There is another circumstance which I think is very important, which is the certificate which is granted; the Act is vague with respect to the medical person. It speaks of him as physician, surgeon, or apothecary; it does not say 'duly authorized to grant a licence,' and, in point of fact, a number of persons, calling themselves apothecaries, do sign certificates, and the Commissioners do not believe that they can prevent them so doing, or that the signature is invalid; and, again, it often happens, and very improperly, as the Commissioners think, that persons sign the certificate in two capacities. For instance, a medical man is, or calls himself, the friend of the person conveyed to the mad-house, and he signs again as a medical person; again, the keeper of a mad-house, who happens to be a medicalperson, signs a certificate, attesting the insanity of the party, and receiving that party into his house. The Commissioners always reprobate and endeavour to check such a practice, but not always successfully."

In the following year (February 19, 1828) Mr. Gordon, in pursuance of the instructions of the Committee, brought in a Bill to amend the law for the regulation of lunatic asylums. He said, among other things, that the medical certificate to be signed by an apothecary was interpreted to mean that it might be signed by any seller of drugs, and hence an apprentice, as soon as his indentures had expired, might consign a man to a mad-house. This reminds me of a mistake into which a distinguished German alienist has recently fallen, not unnaturally, from our double use of the word apothecary. He smiles at the absurdity of the British law allowing a mere druggist to sign a certificate of insanity! Mr. Gordon again refers to Dr. Warburton's house, and the patients in their cribs "wallowing in their filth throughout the whole of Sunday," while on Monday morning they were "in a state of nudity, covered with sores and ordure, and were carried into the yard to be suddenly plunged into cold water, even when ice was in the pails." The speaker added that it was impossible, with the strongest language, to describe the horrors of this place, and even maintained that the evidence before the Committee showed that, however bad, this house was good as compared with others of the same kind—if not much better than many of them.

He maintained that, unfortunately, the provisionmade by 14 Geo. III., c. 49, by which five Commissioners, appointed by the College of Physicians, licensed and were bound to visit these houses yearly, and, if they found anything improper, were directed to state to the College what they had discovered, had never been attended to in practice; at least, since 1800. The excuse for this negligence was that the complaint to the College censors (placed on a card in their room) did no good, and might therefore as well be abandoned. In fact, he found on inquiry that the Commissioners had done nothing—literally and strictly nothing. He then referred to a house where two patients were found lying in an outhouse, and three others chained down by the arms, wrists, and legs. Their wrists were blistered, and their persons covered only by rags. This was within five miles of London. He concluded by moving for leave to bring in a Bill "To Consolidate and Amend the several Acts respecting County Lunatic Asylums, and to Improve the Treatment of Pauper and Criminal Lunatics."

Lord Ashley seconded the motion, and leave was given to bring in the Bill,[159]which passed the House.

In the Upper House Lord Malmesbury moved the second reading of the above Bill. One object, he said, of the Lunatic Asylum Regulation Bill was to give to counties more power in establishing asylums. For private patients, two medical certificates and an order would now be required, and the like for single patients. In regard to the existing College Commissioners, he ridiculed the extraordinary circumstance that if, in the courseof their visits of inspection, they found what was reprehensible in an asylum, they could not revoke the licence which they themselves had given. It was proposed to take the power from the College of Physicians and invest it in fifteen Metropolitan Commissioners appointed by the Home Secretary.[160]

This Act (9 Geo. IV., c. 40), based on the Report of the Committee, was passed July 15, 1828.[161]

The returns of pauper lunatics in England and Wales amounted to 9000, being 6700 in excess of the corresponding return of 1807; but nobody supposes that there had been that, or, in fact, any considerable increase in the number of the insane poor, but simply greater accuracy in obtaining statistics.

Referring back to this period, Lord Shaftesbury, in evidence given before a Committee of the House of Commons thirty years later, and dwelling upon the oldrégime, observed: "I mention these things because they never could be seen now (1859), and I think that those who come after us ought to know what things have existed within the memory of man. At the present time, when people go into an asylum, they see everything cleanly, orderly, decent, and quiet, and a great number of persons in this later generation cannot believe there was ever anything terrible in the management of insanity; and many say, 'After all, a lunatic asylum is not so terrible as I believed.' When we begun our visitations, one of the first rooms that we went into contained nearly a hundred and fifty patients, in everyform of madness, a large proportion of them chained to the wall, some melancholy, some furious, but the noise and din and roar were such that we positively could not hear each other; every form of disease and every form of madness was there; I never beheld anything so horrible and so miserable. Turning from that room, we went into a court, appropriated to the women. In that court there were from fifteen to twenty women, whose sole dress was a piece of red cloth, tied round the waist with a rope; many of them with long beards, covered with filth; they were crawling on their knees, and that was the only place where they could be. I do not think that I ever witnessed brute beasts in such a condition, and this had subsisted for years, and no remedy could be applied to it. It was known to one or two physicians at the Royal College, who visited the place once a year; but they said, fairly enough, that, although they saw these things, they could not amend them." Lord Shaftesbury, after giving a shortrésuméof the condition of the old York Asylum, as well as of that of Bethnal Green in 1827, went on to observe—a paragraph which will form the motto of my work—"I might multiply these instances almost indefinitely, but I thought it was desirable just to indicate the state of things that existed, in order to contrast the Past with the Present."[162]

In the interval between the Act of 1828[163]and the next Act of importance, several attempts were made atfurther legislation on the part of Mr. Gordon and Lord Somerset. A Bill passed both Houses in 1832.[164]In one instance a Bill which passed the Commons was characterized in the House of Lords as "one of the most abominable pieces of legislation that ever was seen." It was "monstrous." "Their lordships could never suffer such an abominable piece of legislation to be thrust down their throats." It is scarcely necessary to say that the lips from which this animated language proceeded were those of Henry Brougham, then the Lord Chancellor. The Bill was, of course, rejected.

In 1842 Lord Somerset brought forward a motion on the inspection of asylums, and pointed out that there was a very large class of persons to whose inspection the Act of 1828 did not apply, viz. those in confinement in their own houses, in separate lodgings, in public institutions, as county asylums, and the hospitals of Bethlem and St. Luke's. The object of his Bill was to extend the system of inspection in force in the metropolitan licensed asylums to the provinces. Barristers, he maintained, should be appointed, with a fixed salary, and not paid for their hour's work and allowed to practise. It is worthy of record that the returns at this period showed that there were about sixty or seventy houses licensed for the reception of insane persons in the country, and that there were actually twenty-five counties in Englandwhere there was not a single asylum licensed for the reception of lunatics, and not one in Wales.

This measure was characterized by Mr. Wakley as not only a very small one, but as an insult to medical men, as it only proposed barristers as the new Commissioners, adding that "in Scotland there was one system, in Ireland there was another, and in England there were several, and among them all there was not one which, on the whole, was entitled to the sanction and approbation of the public, or which was worthy of the adoption of the noble lord [Somerset]."

Lord Ashley approved of the Bill, and speaking of the work of the Commissioners, he said, "They have aimed at a medium line of policy, and an immense amount of human misery had been abated under the present law, and by the industry of those who carry it into execution."

It was in this speech that Lord Ashley made an observation which has not escaped the criticism of the medical profession, namely, "that a man of common sense could give as good an opinion as any medical man he ever knew," that is, "when it has been once established that the insanity of a patient did not arise from the state of his bodily health."[165]

It should be stated that Mr. Wakley moved an amendment on the first clause of the Bill, omitting "Barrister Commissioners," and inserting "Medical Commissioners." He spoke of the total failure of the Metropolitan Commission, and ultimately moved as anamendment that two of the Commissioners to be appointed should not have their profession stated, their appointment being left to the Lord Chancellor. This amendment was carried by a majority of three, but in the Bill provision was made for two more physicians and two more barristers.

On July 16th of the same year, on the motion that the order of the day for the further consideration of the Lunatic Asylums Bill be proceeded with, a member suggested its postponement until further discussion. Lord Somerset replied that the Bill was framed for the purpose of procuring further information on the subject, in order to legislate permanently upon it. On the House going into Committee Lord Ashley expressed a hope that the measure would tend to ameliorate the condition of the pauper lunatics throughout the kingdom. On this occasion Lord Ashley observed, in regard to the system of non-restraint, that he had formerly entertained some doubts as to the practicability of carrying it out; but that these doubts had been removed by a visit to the Hanwell Asylum. Having witnessed the system pursued there, he said he could not speak too highly either of the system itself, or the manner in which it was carried out by Dr. Conolly.

Having passed through Committee, the Bill was read a third time on the 28th of July, 1842, and in this instance was not rejected by the House of Lords.[166]

The Metropolitan Commissioners, invested with their enlarged powers, made a most thorough inquiry into thecondition of the asylums in England and Wales, and presented a Report to Parliament in 1844, which must always possess great historic interest and value.[167]It constitutes the Doomsday Book of all that concerns institutions for the insane at that time.

The state of some asylums visited by the Commissioners was frightfully bad, notwithstanding the general progress which had been made since public attention had been directed to abuses and the several Acts of Parliament had been passed in order to remove them. These things, however, it must be remembered, were survivals of the past, not fair illustrations of the present; abuses which lingered on in spite of light and knowledge, and required stringent pains and penalties to force those who permitted them to abandon their practices.

On the 23rd of July, 1844, the indefatigable reformer of abuses connected with the treatment of lunatics, Lord Ashley, moved for an Address to the Crown, praying her Majesty to take into consideration the Report of the Metropolitan Commissioners in Lunacy[168]to the Lord Chancellor, presented to the House, the statute under which they acted expiring next session. He commented upon there being no official visitation of single houses. He believed that such a power "ought to be confided to some hand that would hunt out and expose the many horrible abuses that at present prevail." The only control was that if such patient resided more thantwelve months in a house, the owner was compelled to communicate the name of that patient to the clerk of the Commission; but for the most part no notice was taken of this law, and it was frequently evaded by removing the patient, after a residence of eleven months, to some other lodging.

At this period (January 1, 1844) the number of lunatics and idiots chargeable to unions and parishes in England and Wales was 16,821. In county asylums there was provision for only 4155, leaving 12,666 poor insane, of whom there were in asylums under local Acts 89, in Bethlem and St. Luke's 121, in lunatic hospitals 343, while 2774 were in private asylums, leaving in workhouses and elsewhere 9339. Although a few of the existing county asylums were well adapted to their purpose, and a very large proportion of them were extremely well conducted, yet some were quite unfit for the reception of insane persons. Some were placed in ineligible sites, and others were deficient in the necessary means of providing outdoor employment for their paupers. Some also were ill contrived and defective in their internal construction and accommodation. Some afforded every advantage of science and treatment; others were wholly deficient in these points. All of them, however, had the advantage of constant supervision, and of not giving any profit to the superintendent. Lord Ashley especially referred to the admirable manner in which the asylums of Wakefield, Hanwell, Lincoln, Lancaster, and Gloucester were managed. "Why, then," his lordship asked, "are not these institutions multiplied?At this moment there are twenty-one counties in England and Wales without any asylum whatever, public or private. The expense is one cause. In some cases the cost of construction has been exceedingly great. The asylum most cheaply constructed is that of Wakefield, of which the average cost per head was £111, whilst the highest price was that of Gloucester, which had cost on the first accommodation £357 per head. In many cases the cost of construction had exceeded £200 per head. The cost of the Bedford Asylum, for 180 patients, was £20,500; that of Gloucester, for 261 patients, £51,366; that of Kent, for 300 patients, was £64,056; that of Hanwell, for 1000 patients, was £160,000, exclusive of £36,000 paid since 1835 for furniture and fittings. On the other hand, the best-constructed union-houses in the country had not cost more than £40 per head." Lord Ashley maintained that although, no doubt, a lunatic asylum was expensive, it ought not to be so to that enormous degree. The reason of this difference he did not know, except that many of them had been constructed with a great display of architecture, and some asylums were far too large. Adopting the opinion of the Report of the Commissioners, he maintained that no asylum forcurablelunatics should contain more than 250 patients, and that perhaps 200 are as large a number as can be managed with the most benefit to themselves and the public in one asylum; and he quoted Dr. Conolly's stronger statement that 100 persons were the highest number that could be managed with convenience in one of these asylums. With regard to thenumber of private patients in asylums, there were 3790, of whom 973 were in private metropolitan, and 1426 in private provincial asylums. The paupers in the private houses were—metropolitan, 854; provincial, 1920. With respect to these, it was a very serious question how far any house should be licensed to take paupers for payment. The principle was very dangerous, and Lord Ashley pointed out that if the superintendent only got seven or eight shillings a week, he still must make a profit, and that there could be no doubt it was so. Quoting the Report of the Commissioners again, he said that many asylums had formerly been private houses; the mansion was sometimes engrossed by the proprietor and a few private patients, while the paupers were consigned to buildings formerly used as offices and outhouses. After adducing evidence of the deplorable condition of certain asylums, Lord Ashley asserted that the only remedy was the multiplication of county asylums, and if advice and example failed, they ought to appeal to the assistance of the law to compel the construction of an adequate number of asylums over the whole country. It was the duty of the State to provide receptacles for the incurable patients, apart from those devoted to remedial treatment. Parochial authorities, however, preferred keeping patients in the workhouse at an expense not exceeding two shillings a week, rather than send them to the county asylum, where the minimum charge was seven shillings a week.

It was true, Lord Ashley observed, that they could show but few instances of restoration to reason. How,indeed, was it possible? They could show, however, a mighty improvement in the condition of the sufferers, the alleviation of their state, their occupations and amusements (all, with some bright exceptions, of recent date), and that the services of religion had infused a momentary tranquillity; but they could show little else, and unless the Legislature should interfere and bring these unfortunates by force within the reach of sympathy and care, for every one restored to his senses we should see a hundred in whom the light of reason would be extinguished for ever. The speaker went on to say that there were two points of deep interest, to which the House would do well to advert for a moment—the question of restraint, and the admission and liberation of patients. "Upon restraint it was unnecessary to dwell very long, as it was a matter of internal arrangement, and beyond their immediate legislation; but he wished to direct the attention of the House to the chapter in the Report which handled that subject, that it might share the general satisfaction, and give praise to those good and able men, Mr. Tuke, Dr. Hitch, Dr. Corsellis, Dr. Conolly, Dr. de Vitré, Dr. Charlesworth and many more, who had brought all their high moral and intellectual qualities to bear on this topic, and had laboured to make rational and humane treatment to be the rule and principle of the government of lunacy."

Lord Ashley pointed out that the law required no medical certificate whatever for a pauper patient, except when admitted into a private asylum. It appears that in Wales at that time there were 1177 pauper lunatics,36 of whom were in English county asylums, and 41 in English licensed houses, 90 in union workhouses, and 1010 living with their friends, many of them being in a wretched condition. Lord Ashley quoted a letter from one of the Commissioners, written in Wales, in which it was stated, "We have met with one case which we think most atrocious. A. B. was sent to the Hereford Asylum from near Brecon on November 28, 1843. She died on January 30th. She was in such a shocking state that the proprietor wished not to admit her; she had been kept chained in the house of a married daughter. From being long chained in a crouching posture, her knees were forced up to her chin, and she sat wholly upon her heels and her hips, and considerable excoriation had taken place where her knees pressed upon her stomach. She could move about, and was generally maniacal. When she died it required very considerable dissection to get her pressed into her coffin! This might be taken as a sample of Welsh lunatics."

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